Whitley Heather P, Fermo Joli D, Chumney Elinor C G
Department of Pharmacy and Clinical Sciences, University Diagnostic Center, South Carolina College of Pharmacy, Charleston, 29425, USA.
Pharmacotherapy. 2006 May;26(5):682-8. doi: 10.1592/phco.26.5.682.
To assess the effect of flag alerts that were placed in electronic medical records on patients' adherence with National Cholesterol Education Program (NCEP) guidelines for secondary prevention of coronary heart disease. A secondary objective was to identify the proportion of patients who were prescribed lipid-lowering agents and assess the barriers of patients who did not reach low-density lipoprotein cholesterol (LDL) goals 5.6 years after the intervention.
Retrospective analysis of a prospective medical record intervention.
University-based primary care clinic.
Eighty-nine adult patients with atherosclerotic vascular disease.
For each patient identified as needing secondary prevention for coronary heart disease according to NCEP guidelines, flags were inserted into the patient's electronic medical record.
Baseline patient data were collected. After 5.6 years, we performed a retrospective analysis. At that time, 72 patients were evaluated; 17 were lost to follow-up. Fifty-four percent of patients (39 of 72 patients) had reached their LDL goal compared with 25% (16 of 64 patients for whom complete lipid panels had been obtained) at baseline (p=0.001). The proportion of patients prescribed lipid-lowering agents rose from 16% at baseline to 75% at follow-up (p=0.0001). However, 33 patients (46%) were above their LDL goal levels at follow-up. Reasons for failure to reach LDL goal were as follows: drug dosage not titrated (10 patients [30%]), adverse drug reaction (four patients [12%]), planned to adjust therapy in the future (three patients [9%]), high drug cost (two patients [6%]), drug contraindicated (two patients [6%]), and non-compliance (one patient [3%]). In 11 patients (33%), the reason for failure was not addressed in the progress notes. Thus, inadequate drug dosage titration (dosage not titrated, planned to adjust therapy, and reason not addressed [assume no action]) occurred in more than 70% of these patients.
These findings emphasize the need for regular evaluation of patients' lipid panels followed by appropriate therapy titration to reach LDL goals. Further study of factors influencing cholesterol management and methods to improve adherence is needed.
评估电子病历中设置的警示标识对患者遵循国家胆固醇教育计划（NCEP）冠心病二级预防指南的影响。次要目的是确定接受降脂药物治疗的患者比例，并评估干预5至6年后未达到低密度脂蛋白胆固醇（LDL）目标的患者所面临的障碍。
对一项前瞻性病历干预进行回顾性分析。
大学附属初级保健诊所。
89例患有动脉粥样硬化性血管疾病的成年患者。
根据NCEP指南，为每位确定需要进行冠心病二级预防的患者在其电子病历中插入警示标识。
收集患者基线数据。5至6年后，进行回顾性分析。当时，72例患者接受了评估；17例失访。54%的患者（72例中的39例）达到了LDL目标，而基线时这一比例为25%（在获得完整血脂检测结果的64例患者中有16例）（p = 0.001）。接受降脂药物治疗的患者比例从基线时的16%升至随访时的75%（p = 0.0001）。然而，33例患者（46%）在随访时LDL水平高于目标值。未达到LDL目标的原因如下：药物剂量未调整（10例患者[30%]）、药物不良反应（4例患者[12%]）、计划在未来调整治疗方案（3例患者[9%]）、药物成本高（2例患者[6%]）、药物禁忌（2例患者[6%]）以及不依从（1例患者[3%]）。在11例患者（33%）中，病程记录未提及未达目标的原因。因此，超过70%的此类患者存在药物剂量调整不足的情况（剂量未调整、计划调整治疗方案以及原因未提及[假设未采取行动]）。
这些发现强调了需要定期评估患者的血脂检测结果，并随后进行适当的治疗调整以达到LDL目标。需要进一步研究影响胆固醇管理的因素以及提高依从性的方法。
